三维彩色多普勒超声心动图直接测量二尖瓣反流的缩流颈面积：体外验证及临床经验
Three-dimensional color Doppler echocardiography for direct measurement of vena contracta area in mitral regurgitation: in vitro validation and clinical experience.
作者信息
Little Stephen H, Pirat Bahar, Kumar Rahul, Igo Stephen R, McCulloch Marti, Hartley Craig J, Xu Jiaqiong, Zoghbi William A
机构信息
The Methodist DeBakey Heart and Vascular Center, Houston, Texas 77030, USA.
出版信息
JACC Cardiovasc Imaging. 2008 Nov;1(6):695-704. doi: 10.1016/j.jcmg.2008.05.014. Epub 2008 Nov 18.
OBJECTIVES
Our goal was to prospectively compare the accuracy of real-time three-dimensional (3D) color Doppler vena contracta (VC) area and two-dimensional (2D) VC diameter in an in vitro model and in the clinical assessment of mitral regurgitation (MR) severity.
BACKGROUND
Real-time 3D color Doppler allows direct measurement of VC area and may be more accurate for assessment of MR than the conventional VC diameter measurement by 2D color Doppler.
METHODS
Using a circulatory loop with an incorporated imaging chamber, various pulsatile flow rates of MR were driven through 4 differently sized orifices. In a clinical study of patients with at least mild MR, regurgitation severity was assessed quantitatively using Doppler-derived effective regurgitant orifice area (EROA), and semiquantitatively as recommended by the American Society of Echocardiography. We describe a step-by-step process to accurately identify the 3D-VC area and compare that measure against known orifice areas (in vitro study) and EROA (clinical study).
RESULTS
In vitro, 3D-VC area demonstrated the strongest correlation with known orifice area (r = 0.92, p < 0.001), whereas 2D-VC diameter had a weak correlation with orifice area (r = 0.56, p = 0.01). In a clinical study of 61 patients, 3D-VC area correlated with Doppler-derived EROA (r = 0.85, p < 0.001); the relation was stronger than for 2D-VC diameter (r = 0.67, p < 0.001). The advantage of 3D-VC area over 2D-VC diameter was more pronounced in eccentric jets (r = 0.87, p < 0.001 vs. r = 0.6, p < 0.001, respectively) and in moderate-to-severe or severe MR (r = 0.80, p < 0.001 vs. r = 0.18, p = 0.4, respectively).
CONCLUSIONS
Measurement of VC area is feasible with real-time 3D color Doppler and provides a simple parameter that accurately reflects MR severity, particularly in eccentric and clinically significant MR where geometric assumptions may be challenging.
目的
我们的目标是前瞻性地比较实时三维（3D）彩色多普勒缩流颈（VC）面积和二维（2D）VC直径在体外模型以及二尖瓣反流（MR）严重程度临床评估中的准确性。
背景
实时三维彩色多普勒可直接测量VC面积，对于MR评估可能比二维彩色多普勒传统的VC直径测量更准确。
方法
使用带有内置成像腔的循环回路，驱动不同搏动流速的MR通过4个不同大小的孔口。在一项针对至少轻度MR患者的临床研究中，使用多普勒衍生的有效反流口面积（EROA）对反流严重程度进行定量评估，并按照美国超声心动图学会的建议进行半定量评估。我们描述了一个准确识别3D-VC面积的分步过程，并将该测量值与已知孔口面积（体外研究）和EROA（临床研究）进行比较。
结果
在体外，3D-VC面积与已知孔口面积的相关性最强（r = 0.92，p < 0.001），而2D-VC直径与孔口面积的相关性较弱（r = 0.56，p = 0.01）。在一项对61例患者的临床研究中，3D-VC面积与多普勒衍生的EROA相关（r = 0.85，p < 0.001）；这种关系比2D-VC直径更强（r = 0.67，p < 0.001）。3D-VC面积相对于2D-VC直径的优势在偏心反流束中更为明显（分别为r = 0.87，p < 0.001对比r = 0.6，p < 0.001）以及在中重度或重度MR中（分别为r = 0.80，p < 0.001对比r = 0.18，p = 0.4）。
结论
使用实时三维彩色多普勒测量VC面积是可行的，并提供了一个能准确反映MR严重程度的简单参数，特别是在几何假设可能具有挑战性的偏心反流和具有临床意义的MR中。
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